Project Summary In the past decade, the role of pharmacists and others as non-traditional vaccine providers is becoming more common. However, as the number of providers administering vaccines increases, there is a concern of fragmented immunization records in state and regional registries. This is a serious issue at the State level as well as at the provider level. Complete immunization records are necessary for the State to monitor vaccination rates and facilitate outbreak response efforts and recalls. For providers, complete records can be used to determine gaps in vaccinations and ensure that individuals are not over-vaccinated. In order for immunization registries to have complete records, it is critical that each provider administering vaccines, including those non- traditional providers such as pharmacists, participate and update the registry each time a vaccine is administered to a patient. In Alabama participation in the registry is not mandatory; as a result, less than 25% of adults over the age of 19 have immunization data recorded in the state registry. Lack of pharmacy participation may have contributed to this incomplete registry records (only 27% of Alabama pharmacies enrolled). Participation of independent pharmacies is of particular concern as approximately 40% of Alabama pharmacies are independent, but only 4% of independent pharmacies are enrolled in the registry. The purposes of this study are to identify barriers to utilization of immunization registries within a pharmacy context and tailor the information learned about barriers into a novel immunization registry training program with strategies specific to individual subsets of pharmacies, independent pharmacies in rural areas. Doing so will help achieve the long-term goal which is to increase the use of immunization registries in community pharmacies in Alabama. The research design is a mixed methods approach to qualitatively identify contextual barriers and facilitators to registry utilization and quantitatively assess effectiveness of the training program and implementation guide through a randomized controlled trial. The specific aims are to 1) identify barriers and best practices of immunization registry implementation, 2) use a participatory design approach to develop an immunization registry training program, and 3) disseminate and assess the impact of the immunization registry training program among community pharmacies' registry participation rates. The impact of the training program on registry participation rates will be assessed using a randomized controlled trial design comparing Alabama community pharmacies' registry data as well as intention to participate. The expected outcome is to create an effective training program that is scalable and ready for dissemination. If successful, this resource can be replicated and used to significantly impact the completeness and accuracy of immunization registries across the U.S., providing the potential for registries to be used consistently in assessing immunization status and recommending additional vaccines in the pharmacy setting, thereby improving vaccination coverage and making the provision of immunizations safe and efficient.